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Being Honest With Your Therapist

Barbara F. Anderson, Ph. D., LCSW

The ability to be honest with one's therapist is related to a number of factors. Trust is a major issue for clients and directly affects how open and forthcoming s/he will be. While time is a great help in the establishment of trust, these days of managed care often make long-term treatment a luxury. Often people cannot afford either the time or the money to engage in a lengthy therapeutic alliance. While trust cannot be rushed, it can be facilitated. In our first meeting I describe to clients the limitations of confidentiality, not risking the possibility that they may confide some piece of information (usually relating to harming self or other) that I must by law reveal. I also tell them how I work, assure them that they can discontinue at anytime, and suggest that we set goals to be reached and assess periodically how we are doing.

Another factor impinging on clients' honesty is whether they want something from the therapist. Within the gender community, the commonest example of an expectation is the endorsement letter for hormones or surgery. Clients, seeing the therapist as having the power to withhold access to the desired service, may censor the information they give in order to conform to the "party line." Some are reluctant to reveal anything that does not mirror a textbook description of a TS seeking sex reassignment --"I knew I wanted to be a girl since I was 3 years old." They will also withhold information such as symptoms of a mental disorder or substance abuse, as they fear these will be used against them. Therapy these individuals takes on an artificial and stilted quality which is ultimately a disservice to such clients who may get the letter they want but not the therapy they need.

Other clients are determined to be "good" clients. They present themselves as extremely compliant, follow every suggestion made by their therapist, describe diminishing symptoms and are always pleasant, agreeable and cooperative. They subsume their natural resistance to another person's suggestions that their ideas, values, attitudes or behavior could be improved and instead trade the opportunity to have an honest exchange for the therapist's approval.

Ironically, the resistant client also has difficulty being honest. This individual is often in therapy unwillingly. Unlike the client who wants his/her endorsement letter, the resistant client wants nothing from the therapist. Often coerced into therapy by a spouse or parent, this person is determined to maintain a neutral and unyielding facade until the therapist declares the experience futile and terminates therapy.

The guilt-ridden client encounters many obstacles in being honest in therapy. S/he has such difficulty with shame that the risk of being open is too great to contemplate. These clients need to address their shame-based existence with their counselor before they can work on the specific issues that brought them into therapy.

If you are thinking about entering therapy, consider the importance of being honest and open in revealing personal information, opinions and attitudes. Assess your counselor for trustworthiness and once satisfied in this area, tell all. You will have a far more successful therapeutic outcome.

Dr. Anderson is located at 1537 Franklin St, Suite 104, San Francisco, CA 94109, 415-776-0139.

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